Abstract:

We have retrospectively analyzed results of 100 patients’ interventional radiology methods in cases of difficulties during endoscopy choledocholithiasis treatment. It was determined that transcutaneous transhepatic cholangiostomy is a universal method of biliary decompression in case of dilatation of intrahepatic bile ducts, and can be the first stage of treatment in patients with choledocholithiasis which may be transformed consistently in endoscopic interventions, or – in case of its inefficiency or inexpediency may be transformed into percutaneous choledocholithotripsy and lithoextraction. The number of choledocholithotripsy and lithoextraction varied from 1 to 3 interference. Adequacy of lithoextraction from common bile duct was controlled by the repeated direct cholangioscopy and was confirmed by antegrade cholangiography. Complications of transhepatic method of choledocholithotripsy and lithoextraction included bacterial shock (6%), insignificant hemobilia (8%), migration (4%) and dislocation of cholangiostomy with disturbance of its drainage function (7%). Complications were eliminated successfully and didn’t change treatment tactic. There were no fatal outcomes in investigated group of patients. Antegrade percutaneous choledocholithotripsy and lithoextraction is the method of choice in case of impossibility of transpapillary endoscopical or traditional surgical treatment of choledoholithiasis.

References

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Abstract:

Currently, the combination of acute cholecystitis complicated by choledocholithiasis is quite common.

Aim: was to improve the efficiency of diagnosis of complicated forms of gallstone disease (acute cholecystitis complicated by choledocholithiasis).

Materials and methods: study included 118 patients with acute cholecystitis complicated by choledocholithiasis. The age of patients ranged from 16 to 92 years (mean age 61,5 ± 2,5 years). Women were 86(78.5%), men - 32 (21.5%). All patients underwent ultrasound examination of the abdominal cavity, hepatobiliary scintigraphy (HBSG), MRI-cholangiography (MRHG), endoscopic retrograde cholangiopancreatography (ERCP) and biochemical blood tests with determination of total bilirubin, amylase, alanine aminotransferase (ALT) and aspartate aminotransferase (AST), alkaline phosphatase (ALP), total protein and protein fractions.

Results: in the diagnosis of choledocholithiasis sensitivity of ultrasound was 86%; HBSG - 97% MRHG - 92%. Basing on these data of sensitivity of different diagnostic methods, we developed diagnostic algorithm of acute cholecystitis complicated by choledocholithiasis: US → HBSG (if inefficient US ir terms of visualization of the distal common bile duct) → MRHG (to clarify causes of focal disorders of transport of labeled bile, according to HBSG) → ERCP: endoscopic papillosphincterotomy (EPST) and lithoextraction (LE) (detected choledocholithiasis or lingering doubts in the diagnosis).

Conclusions: the use of the diagnostic algorithm for acute cholecystitis in many cases allows timely identification of choledocholithiasis, followed by the implementation of adequate endoscopic sanitation of biliary tract, before performing cholecystectomy . 

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